| NPI | 1144339383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5018574) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP3209042) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-10-10 |