NPI | 1184605123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP 9198184) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN 063105 NP) |
Enumeration Date | 2005-11-08 |
Last Update Date | 2008-05-12 |