| NPI | 1073181285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11013687) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F06211079) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2023-04-25 |