| NPI | 1245802610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11014210) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 11014210) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2022-03-03 |