| NPI | 1093299950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9455750) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9455750) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2022-02-28 |