| NPI | 1477857167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP11006444) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9256576) |
| 163WC1500X Registered Nurse, Community Health (Licence: FL RN9256576) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2021-10-28 |