| NPI | 1205518065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11028427) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9502733) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-09-06 |