| NPI | 1639441645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9292629) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9292629) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2023-03-01 |