| NPI | 1831494731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11045188) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP2944) |
| 163W00000X Registered Nurse (Licence: FL RN9629785) | |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2026-01-29 |