| NPI | 1447951199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11026732) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9406598) |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2023-08-14 |