| NPI | 1316299936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN115908) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP 2987192) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2020-09-19 |