| NPI | 1427597244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9330103) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL ARNP9330103) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2021-07-12 |