| NPI | 1861244048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024459) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11024459) |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2024-05-15 |