| NPI | 1356961494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 224076) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 150031) |
| Enumeration Date | 2020-04-18 |
| Last Update Date | 2022-11-10 |