| NPI | 1972125987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11028071) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9512841) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2023-10-12 |