| NPI | 1659963882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 229112) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS 904460) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 904460) | |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2023-05-02 |