| NPI | 1497183404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11017993) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: FL 11017993) |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2025-03-06 |