| NPI | 1275002883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000954) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9424378) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2024-05-31 |