| NPI | 1851930200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11005553) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11005553) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-05-20 |