| NPI | 1619077344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9191829) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9191829) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2016-12-29 |