| NPI | 1508181850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9319542) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TN 12556) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2022-01-21 |