| NPI | 1922442508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9281426) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F338395) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2024-03-27 |