| NPI | 1265034763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010110) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9342819) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2020-11-10 |