| NPI | 1093164667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL aprn9343190) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9343190) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2020-04-06 |