| NPI | 1942789672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9232235) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9232235) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2025-01-07 |