| NPI | 1205327228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9165174) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9165174) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2026-02-17 |