| NPI | 1184218612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11009425) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11009425) |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2023-10-09 |