| NPI | 1700027430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9260562) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8758) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2022-07-21 |