| NPI | 1487385977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27436) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11020279) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2023-07-05 |