| NPI | 1366254393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11032227) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9617823) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-03-24 |