| NPI | 1558940395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11012445) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: FL 11012445) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-08 |