| NPI | 1902809023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP1940482) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP1907) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM R54053) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-09-19 |