| NPI | 1750762654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11002188) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL 022376300) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2022-04-04 |