| NPI | 1548783814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MT NP44335) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: IA A094433) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-07-21 |