| NPI | 1821752676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 5663497-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 56634973102) |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2022-10-18 |