| NPI | 1174996037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9358826) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: FL ARNP-9358826) |
| Enumeration Date | 2015-11-01 |
| Last Update Date | 2023-06-30 |