| NPI | 1952088189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11028660) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9357984) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2023-09-15 |