| NPI | 1881107217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11039215) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT33159) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2025-05-06 |