| NPI | 1427412212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9304541) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9304541) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2022-02-09 |