| NPI | 1528637097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC ROEG-UATMG) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 334075) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-02-07 |