| NPI | 1235741141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11008585) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11008585) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2022-11-15 |