| NPI | 1316725039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11035163) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: FL 9519275) |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2024-09-16 |