| NPI | 1093348674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL F01200853) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9340113) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL none) | |
| 363L00000X Nurse Practitioner (Licence: FL 11005972) | |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2024-09-21 |