| NPI | 1336601723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 903370) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 204457) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2021-07-08 |