| NPI | 1023424587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9251191) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9251191) |
| Enumeration Date | 2014-07-05 |
| Last Update Date | 2023-01-26 |