| NPI | 1285049577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9393818) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-125388) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2021-08-10 |