| NPI | 1104333061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9362350) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9362350) |
| 207Q00000X Family Medicine (Licence: FL 9362350) | |
| Enumeration Date | 2018-01-01 |
| Last Update Date | 2019-02-14 |