| NPI | 1871322750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 1261075) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID F07240792) |
| Enumeration Date | 2024-07-30 |
| Last Update Date | 2024-09-04 |