| NPI | 1548908874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11019443) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-263328) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2022-07-13 |