| NPI | 1932150596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 3283032) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ARNP3283032) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-01-15 |