| NPI | 1710386446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9243384) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9243384) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2023-08-18 |