| NPI | 1932350428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11011041) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PTA19241) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2021-01-21 |