| NPI | 1881147767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP936157) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP 9361517) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2022-08-24 |