| NPI | 1497271563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP3164192) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP3164192) |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2022-07-21 |