| NPI | 1619411881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9182557) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9182557) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2024-01-02 |