| NPI | 1912556283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11003977) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11003977) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2023-03-31 |