| NPI | 1699423012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11018683) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL aprn11018683) |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2024-06-18 |