| NPI | 1598420911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021044045) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R098414) |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2023-03-01 |