| NPI | 1568953669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9374264) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9374264) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2024-08-05 |