| NPI | 1518494020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 3-001878) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ AP10070) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2024-11-22 |