| NPI | 1770263725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11027085) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F06231398) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-09-29 |