| NPI | 1295357424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11008015) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11008015) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2026-01-26 |