| NPI | 1093114928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11025307) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9268724) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11025307) | |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2023-08-07 |