| NPI | 1003084278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9219002) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: FL EMT 304782) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2020-07-05 |