| NPI | 1679795348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP2906752) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RNNP117192) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-01-16 |