| NPI | 1649913096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 175647) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 105871) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2023-09-29 |