| NPI | 1871390476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R198192) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: MD R198192) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R198192) | |
| Enumeration Date | 2025-03-01 |
| Last Update Date | 2025-03-01 |