| NPI | 1962073999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11014075) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2022-02-25 |