| NPI | 1992338321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11005336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL APRN11005336) |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2020-10-02 |