| NPI | 1205346392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9357076) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL arnp9357076) |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2018-01-18 |