| NPI | 1932673209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000250) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11000250) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2021-11-17 |