| NPI | 1336378124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 1160A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID n-26795) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2024-09-24 |