| NPI | 1528509312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9367454) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9367454) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2020-02-28 |