| NPI | 1013275635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9219496) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9219496) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2014-11-13 |