| NPI | 1629181110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP 9346857) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN110241 np) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2014-07-10 |