| NPI | 1073148730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 39089) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11006408) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2024-04-02 |