| NPI | 1033771787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11003063) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 11003063) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2019-07-02 |