NPI | 1003367251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11041755) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2016-10-21 |
Last Update Date | 2025-08-22 |