| NPI | 1780302760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11021437) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F08220658) |
| Enumeration Date | 2022-08-16 |
| Last Update Date | 2025-02-05 |