| NPI | 1558964809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11024189) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28224636A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71010715A) | |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2025-01-22 |