| NPI | 1376057166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 201571) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 121585) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2022-02-09 |