| NPI | 1376272716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11020144) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5016445) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2025-09-19 |