| NPI | 1083199442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11013782) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11013782) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5011044) | |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2021-10-11 |