| NPI | 1417679762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11021418) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11021418) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL 11021418) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11021418) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: FL 11021418) | |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL 11021418) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: FL 11021418) | |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2024-09-15 |