| NPI | 1881107019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11016417) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP09640) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2022-05-03 |