| NPI | 1760139554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11018844) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F03220042) |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-09-27 |