| NPI | 1174001739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9378608) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9378608) |
| Enumeration Date | 2018-08-04 |
| Last Update Date | 2020-12-02 |