| NPI | 1043791148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9292612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 9292612) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2023-09-11 |