| NPI | 1740584135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9250622) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R218105) |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2023-06-28 |