| NPI | 1407561236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11024345) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL RN9513471) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2024-08-13 |