| NPI | 1205331972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11017433) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9537097) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-02-21 |