| NPI | 1235574484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS47176) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9574671) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11023966) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2023-01-23 |