| NPI | 1891260725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9392272) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9392272) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2026-07-15 |