| NPI | 1689079337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9326689) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9326689) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2019-11-20 |