| NPI | 1588238711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11019650) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: FL PMD525524) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2022-05-20 |