| NPI | 1326579996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9362596) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9362596) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2018-03-17 |