| NPI | 1235612771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9392136) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ARNP9392136) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2021-10-18 |