| NPI | 1518586775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: LA 212041) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 212041) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2021-06-10 |