| NPI | 1245642180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11010959) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5180825) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2021-08-04 |