| NPI | 1457696452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9315397) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9315397) |
| Enumeration Date | 2012-12-01 |
| Last Update Date | 2015-07-07 |