| NPI | 1871079111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 735782) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9283795) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2023-12-29 |