| NPI | 1669924452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002210) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 050764-21) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2024-11-21 |