| NPI | 1144868753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11005403) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL RN9353437) |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2020-07-24 |