| NPI | 1639626997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0992741-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AK 114971) |
| Enumeration Date | 2016-09-04 |
| Last Update Date | 2024-01-24 |