| NPI | 1336771823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11006701) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL rn9259087) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2024-08-07 |