| NPI | 1588998447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-02226) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 79550) |
| 363L00000X Nurse Practitioner (Licence: FL ARNP 9190765) | |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2024-06-13 |