| NPI | 1811441934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 7247) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60685766) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2022-02-28 |