| NPI | 1942954268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 224208) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 224208) |
| Enumeration Date | 2022-02-06 |
| Last Update Date | 2022-03-24 |