| NPI | 1538933205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11029636) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9318333) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-11-13 |