| NPI | 1770218653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11021910) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA 283241) |
| Enumeration Date | 2022-07-23 |
| Last Update Date | 2022-11-24 |