| NPI | 1538751862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11011526) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9444075) |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2021-02-08 |