| NPI | 1902550460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11018353) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F022220136) |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2023-02-01 |