| NPI | 1326744079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11024271) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024271) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2025-07-10 |