| NPI | 1164119095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11026857) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9423493) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-06-14 |