| NPI | 1538994520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11035160) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 675030) |
| Enumeration Date | 2024-09-07 |
| Last Update Date | 2024-09-10 |