| NPI | 1942482880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9203742) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9203742) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL RN 9203742) | |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2016-06-09 |