| NPI | 1902201874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9366704) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9366704) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2024-01-16 |