| NPI | 1043736176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9271517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ARNP9271517) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2019-10-03 |