| NPI | 1326704230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11015367) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 11015367) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2023-02-20 |