| NPI | 1497749519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000796) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 201158) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2025-07-02 |