| NPI | 1174256044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11020560) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11020560) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2023-01-05 |