| NPI | 1205207883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9299825) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9299825) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2021-04-08 |