| NPI | 1386386043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11018757) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 11018757) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11018757) | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2024-02-13 |