| NPI | 1316714538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11030028) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F11230474) |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2024-08-09 |