| NPI | 1548774524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R184486) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11038961) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2025-09-06 |