| NPI | 1578306734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11033450) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9517442) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-11-01 |