| NPI | 1790409886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11027905) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PR 4357) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2023-10-05 |