| NPI | 1083004113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9214730) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9214730) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2019-10-01 |