| NPI | 1821496118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9259258) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9259258) |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2019-04-24 |