| NPI | 1780024166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9291362) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: FL RN9291362) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: FL APRN9291362) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2023-08-07 |