| NPI | 1073218152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11025040) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: FL 11025040) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11025040) | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |