| NPI | 1649672528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9355875) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9355875) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2024-01-08 |