| 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 |