| NPI | 1669835112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11016387) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 163W00000X Registered Nurse (Licence: FL 9500673) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2022-01-18 |