| NPI | 1417566647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006228) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11006228) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11006228) | |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2020-09-10 |