| NPI | 1306654447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11037558) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL 2023129213) |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2025-02-28 |