| NPI | 1518482710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5009800) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NC 251632) |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2021-01-26 |