| NPI | 1720480445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9273908) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9273908) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2022-07-21 |