| NPI | 1619574555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 212538) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR 212538) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2021-10-13 |