| NPI | 1376074682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9397007) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN296323) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9397007) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-01-31 |