| NPI | 1548872567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11008656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS8656) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2022-02-04 |