| NPI | 1609401728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-169684) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-169684) |
| 363L00000X Nurse Practitioner (Licence: AL 1-169684) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2022-04-01 |