NPI | 1922715978 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11022813) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL APRN11022813) |
363LF0000X Nurse Practitioner, Family (Licence: FL F10221382) | |
Enumeration Date | 2022-10-31 |
Last Update Date | 2025-07-30 |