| NPI | 1508526906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 124266) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2012033419) |
| 163W00000X Registered Nurse (Licence: AR 124266) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2021043578) | |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2022-11-01 |