| NPI | 1841927100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11021267) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL RN9390729) |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2022-08-08 |