| NPI | 1790102796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9229372) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9229372) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2016-03-08 |