| NPI | 1699539007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11030948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 11030948) |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2026-04-17 |