| NPI | 1780039032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11013969) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R186964) |
| Enumeration Date | 2016-04-24 |
| Last Update Date | 2021-08-19 |