| NPI | 1679054100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9275437) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL RN9275437) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2020-09-15 |