| NPI | 1538611975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: AR A004938) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AR A004938) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2024-12-20 |