| NPI | 1033718986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11009951) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL F09201237) |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2021-12-22 |