| NPI | 1124612114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11047375) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9301627) |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2026-05-11 |