| NPI | 1689288144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MA RN211735) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ TEMP246634) |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2023-04-06 |