| NPI | 1699318295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11005649) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 345197) |
| Enumeration Date | 2019-10-26 |
| Last Update Date | 2025-01-31 |