| NPI | 1508245838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 505017588) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 3247082) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP3247082) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2023-02-07 |