| NPI | 1700242559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9336489) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL ARNP 9336489) |
| 163W00000X Registered Nurse (Licence: FL 9336489) | |
| Enumeration Date | 2016-01-09 |
| Last Update Date | 2021-03-25 |