| NPI | 1558885327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 61801) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-70079) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 61801) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2024-06-11 |