| NPI | 1366118424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 9266693-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 9266693-4405) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2024-07-30 |