| NPI | 1457901779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11015204) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-172573) |
| 163W00000X Registered Nurse (Licence: FL RN9344367) | |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2021-11-02 |