| NPI | 1295320638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11026549) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9357422) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2023-05-26 |