| NPI | 1346753522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010050) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021002927) |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2023-03-30 |