| NPI | 1225807977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11030280) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9573508) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2024-02-04 |