| NPI | 1538541578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024907) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2024-04-08 |