NPI | 1477221281 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11010451) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 110104561) |
Enumeration Date | 2021-09-06 |
Last Update Date | 2025-04-29 |