| NPI | 1154600963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9480216) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN275639) |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 048991-23) | |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2023-03-12 |