| NPI | 1306402391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002444) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11002444) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2026-03-03 |