| NPI | 1063484129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11008434) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11008434) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11008434) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2023-06-12 |