| NPI | 1891748000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 6433) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 851-033) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2021-01-19 |