| NPI | 1992424923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 279848) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 279848) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2023-08-21 |