| NPI | 1255898102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000215) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: FL RN9181705) |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2019-02-27 |