| NPI | 1194298851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11001311) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9310926) |
| 2085B0100X Radiology, Body Imaging (Licence: FL 73358) | |
| Enumeration Date | 2019-01-05 |
| Last Update Date | 2022-08-10 |