| NPI | 1841774171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000320) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL 9344848) |
| Enumeration Date | 2018-09-22 |
| Last Update Date | 2023-08-11 |