| NPI | 1124427521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9198431) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9198431) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9198431) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2021-09-15 |