| NPI | 1750867271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 53923) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP11559) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-11-05 |