| NPI | 1316523632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 11018979) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL F03220677) |
| 104100000X Social Worker | |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2022-03-31 |