| NPI | 1770915803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11007075) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9308008) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2020-05-27 |