| NPI | 1780085548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9366845) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9366845) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2015-04-14 |