| NPI | 1841629417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9380731) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-103235) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2020-05-22 |