| NPI | 1275171233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11005152) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11005152) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2023-08-02 |