| NPI | 1427232107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11013625) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 602855) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: FL RN9290651) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11013625) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2021-08-20 |