| NPI | 1063870889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9491899) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-100230) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2019-12-20 |