| NPI | 1942959481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NM 69330) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM NM-86070) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-08-11 |