| NPI | 1386245652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010371) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F10201183) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2023-06-14 |