| NPI | 1790226942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006869) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024174657) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2022-03-15 |