| NPI | 1992566079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11031625) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11031625) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-04-03 |