| NPI | 1821416843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11004484) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9496639) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2023-11-08 |