| NPI | 1639425630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9293769) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL RN9293769) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2024-02-14 |