| NPI | 1710970454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP 2970352) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ME2970352) |
| 363L00000X Nurse Practitioner (Licence: NC 5006793) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2016-09-10 |