| 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 |