| NPI | 1356509129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9420829) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN325609) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2024-01-31 |