| NPI | 1770248957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PR 4057) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11015903) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2022-08-08 |