| NPI | 1598744989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 3265752) |
| Additional Taxonomies | 367A00000X Advanced Practice Midwife (Licence: FL 3265752) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2020-01-30 |