| NPI | 1942947825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11018377) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9521286) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2022-05-12 |