| NPI | 1386316453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11021501) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9532277) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2022-09-15 |