| NPI | 1760738728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11030031) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1200A) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2024-03-06 |