| NPI | 1760003842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL F02200533) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9467258) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2022-02-18 |