| NPI | 1992438618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11021151) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9402559) |
| 146N00000X Emergency Medical Technician, Basic (Licence: FL 539895) | |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-08-03 |