| NPI | 1386169613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9325614) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9325614) | |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2018-03-17 |