| 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 | 2026-07-17 |