| NPI | 1902317217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP2859012) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP2859012) |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2020-03-19 |