| NPI | 1659150001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL F08230440) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F08230440) |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2025-03-11 |