| NPI | 1275975237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9432066) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9432066) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2022-05-04 |