| NPI | 1316480429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-2113) |
| Additional Taxonomies | 286500000X Military Hospital (Licence: HI APRN-2113) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2025-03-03 |