| NPI | 1972970424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9340317) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL APRN9340317) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2023-04-13 |