| NPI | 1497125520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9337727) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9337727) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9337727) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9337727) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9337727) | |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2021-12-28 |