| NPI | 1528640604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 71551) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AR R104122) |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2023-08-25 |