| NPI | 1508308859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9368910) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024174304) |
| 363L00000X Nurse Practitioner (Licence: TN 28495) | |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2024-10-18 |