| NPI | 1609244326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9304102) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9304102) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2026-06-01 |