| NPI | 1013671569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015750) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11015750) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11015750) | |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2024-06-08 |