| NPI | 1508405473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11005953) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9377499) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-12-24 |
| Last Update Date | 2020-01-29 |