| NPI | 1407029697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9305008) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 304789) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2012-06-13 |