| NPI | 1841531647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 67431) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN AP20569) |
| 363L00000X Nurse Practitioner (Licence: CO C-APN.0000931-C-NP) | |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2022-12-20 |