| NPI | 1750927927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 235004) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 5613376-4405) |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2020-11-20 |