| NPI | 1538667936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11009754) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2024-02-14 |