| NPI | 1992210884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11017341) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 23566) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2022-04-08 |