| NPI | 1700590734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5020174) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5020174) |
| 363LS0200X Nurse Practitioner, School (Licence: NC 304292) | |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2024-07-02 |