| NPI | 1235667205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL aprn11006893) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024174887) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2022-03-09 |