| NPI | 1588928659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11016631) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-088602) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2022-01-31 |