| NPI | 1316533433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11010409) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL aprn11010409) |
| Enumeration Date | 2020-12-13 |
| Last Update Date | 2023-11-15 |