NPI | 1952792822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP 9244990) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9244990) |
Enumeration Date | 2015-02-12 |
Last Update Date | 2015-05-26 |