| NPI | 1740603141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL 9365354) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: FL 9365354) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2019-02-22 |