| NPI | 1568876191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9340100) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F338725-1) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2024-09-25 |