| NPI | 1679023311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 225804) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 110261-8934) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2025-01-30 |