| NPI | 1457018145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11016526) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11016526) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11016526) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL F11210321) | |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2025-10-07 |