| NPI | 1679022289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9388429) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP 9388429) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2026-03-06 |