| NPI | 1235635657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MA RN2312614) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY F343166) |
| 363LF0000X Nurse Practitioner Family (Licence: FL APRN11030223) | |
| 363LF0000X Nurse Practitioner Family (Licence: FL TPAN570) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2024-09-12 |