| NPI | 1801484548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11008381) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11008381) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2022-08-31 |