| NPI | 1811614365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL F10221073) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1152535) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2024-07-19 |