| NPI | 1427788348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9524250) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F06220224) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-06-14 |