| NPI | 1942048954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11033998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 11033998) |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2024-11-11 |