| NPI | 1740870070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 833724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 833724) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2022-04-14 |