| NPI | 1376042168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR A005500) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR A005500) |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2020-04-10 |