| NPI | 1740880848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11009931) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9485891) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2021-07-26 |