| NPI | 1285318956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11026086) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL 1026086) |
| Enumeration Date | 2023-06-13 |
| Last Update Date | 2023-07-03 |