| NPI | 1841667359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 20653) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 276784) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC F0815311) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2024-01-24 |