| NPI | 1730434747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002373) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2012026925) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2019-10-29 |