| NPI | 1083042618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002944) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL rn9325936) |
| 207Q00000X Family Medicine (Licence: FL APRN11002944) | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2019-07-30 |