| NPI | 1023332848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11016567) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 595740) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F308343) | |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2023-07-10 |