| NPI | 1699285635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11007310) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9405402) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2020-06-11 |