| NPI | 1962395392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11040471) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MN 2465074) |
| Enumeration Date | 2025-06-03 |
| Last Update Date | 2025-11-10 |