| NPI | 1477316685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: NV 93179) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 874996) |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2024-08-23 |