| NPI | 1427533728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002269) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN000024742) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2024-02-13 |