| NPI | 1629577119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC APN.23998) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP10948) |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2020-10-05 |