| NPI | 1730668765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9325367) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: FL APRN9325367) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2021-03-31 |