| NPI | 1083377964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015984) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11015984) |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2024-10-21 |