| NPI | 1982984787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MI 4704384689) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP 2732292) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN2732292) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2022-07-28 |