| NPI | 1336648104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9286129) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9286129) |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2021-07-08 |