| NPI | 1821762600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN10115591) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL RN9518408) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2023-01-11 |