| NPI | 1346940848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11025109) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F03230099) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-12 |