| NPI | 1669706297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11025243) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2023-03-31 |