| NPI | 1922491588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9456430) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2021-08-19 |