| NPI | 1255183265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11032094) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL 13589) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2024-04-03 |