| NPI | 1538949896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5019138) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC AG09230015) |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2024-12-10 |