| NPI | 1457036071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11027068) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9598815) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11027068) | |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-06-20 |