| NPI | 1811341324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 23445) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OR 201507032NP-PP) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2019-11-25 |