| NPI | 1841862729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 904632) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 220985) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2022-04-05 |