| NPI | 1669246344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL F10231201) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11029622) |
| 363L00000X Nurse Practitioner (Licence: FL F10231201) | |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-12-18 |