| NPI | 1407481757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006441) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11006441) |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2024-05-23 |