| NPI | 1508968488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9168596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL RN9168596) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2022-10-27 |