| NPI | 1730665738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9224449) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9224449) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2023-05-17 |