| NPI | 1992303101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024706) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL 100985) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2023-04-14 |