| NPI | 1871063875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 11000557) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9500352) |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2024-01-31 |