| NPI | 1881235059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004883) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL rn9317915) |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2019-10-30 |