| NPI | 1861790537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP3179972) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: FL ARNP3179972) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2020-01-23 |