| NPI | 1033440136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11007909) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9292622) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2021-02-10 |