| NPI | 1841898061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11009379) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11009379) |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2021-10-28 |