| 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 |