| NPI | 1154789428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9283734) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL RN9283734) |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2022-07-21 |