| NPI | 1538799747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11006675) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9365661) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95239375) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006675) | |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2024-07-28 |