| NPI | 1356858807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9297304) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9297304) |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2018-02-13 |