| NPI | 1396480851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5016190) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC Hatt-70BNF) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2023-08-07 |