| NPI | 1184240632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11007548) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 11007548) |
| Enumeration Date | 2020-06-21 |
| Last Update Date | 2020-11-17 |