| NPI | 1316606981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015555) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11015555) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F350941) | |
| Enumeration Date | 2021-12-10 |
| Last Update Date | 2023-11-03 |