| NPI | 1336712033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11014417) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11014417) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2022-01-24 |