| NPI | 1881068781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11019194) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-2017) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2022-08-17 |