| NPI | 1497368823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11023948) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F343783-1) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2025-04-04 |