| NPI | 1104477306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004877) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL RN3059232) |
| Enumeration Date | 2019-09-28 |
| Last Update Date | 2023-02-27 |