| NPI | 1700408804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11007397) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL 9372778) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11007397) | |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2025-10-13 |