| NPI | 1720080310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5004025) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP3170972) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2022-08-30 |