| NPI | 1609249499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9363107) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2024-03-20 |