| NPI | 1538750104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11007885) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9436439) |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2021-02-05 |