| NPI | 1366220873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11028485) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11028485) |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2024-02-01 |