| NPI | 1124638911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11007998) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11007998) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2021-08-31 |