| NPI | 1770269946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11033454) |
| Additional Taxonomies | 363LS0200X Nurse Practitioner, School (Licence: FL RN9627713) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2024-06-17 |