| NPI | 1508361841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282NR1301X General Acute Care Hospital, Rural |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA Rn209111) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2023-09-21 |