| NPI | 1386246254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11010334) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F11200231) |
| Enumeration Date | 2020-11-14 |
| Last Update Date | 2020-12-02 |