| NPI | 1881399491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A173793) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A173793) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IA A173793) | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-07-11 |