| NPI | 1215410220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9446478) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL 9446478) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2024-01-16 |