| NPI | 1730513094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11009021) |
| Additional Taxonomies | 104100000X Social Worker |
| 363L00000X Nurse Practitioner (Licence: FL APRN11009021) | |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2025-04-10 |