| NPI | 1437621612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F343879) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60939311) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC APN.22455) | |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2020-03-25 |