| NPI | 1861871717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9456166) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.012866) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-01-04 |