| NPI | 1346918596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 113755) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: NE 77859) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2021-09-02 |