| NPI | 1275719890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11000698) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12138) |
| 163WG0000X Registered Nurse, General Practice (Licence: FL 9176378) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2018-12-21 |