| NPI | 1427596550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5016951) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9316860) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2022-11-15 |