| NPI | 1831477397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN2629912) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL RN2629912) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2023-02-21 |