| NPI | 1346419686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 4476-33) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WI 383-055) |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 4476-33) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 4476-33) | |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2023-05-23 |