| NPI | 1356864300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL F04210204) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2021-08-13 |