| NPI | 1649996869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11022528) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11022528) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2024-03-25 |