| NPI | 1225597917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11001832) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11001832) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2021-09-16 |