| NPI | 1730449604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9415612) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NY F304318-1) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2016-09-23 |