| NPI | 1992315352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013493) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: NC 215487) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2020-09-01 |