| NPI | 1366673741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL APRN9286541) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9286541) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2023-05-01 |