| NPI | 1265823330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5008341) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9483373) |
| 363L00000X Nurse Practitioner (Licence: NC 5008341) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 0000018806) | |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2024-04-26 |