| NPI | 1861091308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11010084) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9323740) |
| Enumeration Date | 2020-10-24 |
| Last Update Date | 2020-11-06 |