| NPI | 1598177586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11003980) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9248483) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11003980) | |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2022-08-26 |