| NPI | 1134644487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9486854) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-140375) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 1-140375) | |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2023-02-20 |