| NPI | 1972003499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9232935) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: FL APRN9232935) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2024-07-02 |