| NPI | 1194210807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11000722) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: FL APRN) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2023-07-23 |