| NPI | 1477163665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11008394) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2021-03-18 |