| NPI | 1417377870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1586A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201393795NP-PP) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2023-02-27 |