| NPI | 1568833564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9238190) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024174741) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2024-05-17 |