| NPI | 1497462246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11022842) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 661239) |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2022-11-02 |