| NPI | 1760054126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11014050) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 11014050) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-05-06 |