| NPI | 1770016321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R251385) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 159981) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP133778) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2024-02-02 |