| NPI | 1629645973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11013348) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL APRN11013348) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2023-10-09 |