| NPI | 1235660861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9367463) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9367463) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2020-06-03 |