| NPI | 1689482523 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL F02240508) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9607981) | 
| 363L00000X Nurse Practitioner (Licence: FL 11031634) | |
| Enumeration Date | 2024-12-23 | 
| Last Update Date | 2024-12-23 |