| NPI | 1346721891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9475918-4405) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: UT 9475918-3102) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2019-01-22 |