| NPI | 1841658622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9456585) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209013854) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2022-07-21 |