| NPI | 1548801699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004303) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11004303) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11004303) | |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2025-04-03 |