| NPI | 1295357051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11007202) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL 9350626) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2021-08-20 |