NPI | 1730704453 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11007542) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11007542) |
Enumeration Date | 2020-06-09 |
Last Update Date | 2025-06-03 |