| NPI | 1447083175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA 213374) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA 213374) |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2024-08-20 |