| NPI | 1881292217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11009700) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9423575) |
| Enumeration Date | 2020-10-16 |
| Last Update Date | 2024-08-29 |