| NPI | 1417474180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9346173) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN214796) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2023-01-13 |