| NPI | 1497212799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11001601) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11001601) |
| Enumeration Date | 2019-02-23 |
| Last Update Date | 2025-12-17 |