| NPI | 1275950826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN9310270) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9310270) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2022-12-08 |