| NPI | 1861041238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NE 112951) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NE 112951) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2021-01-13 |