| NPI | 1801489497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN1101662) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11011662) |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2024-05-31 |