| NPI | 1245726439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9301886) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9301886) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2019-03-13 |