| NPI | 1548772676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 10170903) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9323174) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2024-03-15 |