| NPI | 1174337711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11038100) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL 11038100) |
| Enumeration Date | 2025-02-04 |
| Last Update Date | 2025-04-02 |