| NPI | 1437427655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN9244105) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 9244105) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2019-05-14 |