| NPI | 1457912529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R43140) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: ND R43140) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-11-27 |