| NPI | 1932565355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 11030183) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2023-12-20 |