| NPI | 1528622719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000466) |
| Additional Taxonomies | 363LX0106X Nurse Practitioner, Occupational Health (Licence: FL 11000466) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2025-01-15 |