| NPI | 1104362904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9280339) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: FL 9280339) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2023-04-21 |