| NPI | 1780155366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 5013019) |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2023-12-08 |