| NPI | 1487239273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11011734) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL APRN11011734) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11011734) | |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2022-07-20 |