| NPI | 1356641989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9427644) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7622533-3102) |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2023-03-07 |