| NPI | 1841825775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11006474) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F03200049) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2022-02-01 |