| NPI | 1689786063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11009893) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9240801) |
| 2471V0105X Radiologic Technologist Vascular Sonography (Licence: FL 81140) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-11-03 |