| NPI | 1427788835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11020082) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11020082) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2023-08-01 |