| NPI | 1447310206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 2834542) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP2834542) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2019-05-14 |