| NPI | 1023557386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9351773) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9351773) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9351773) | |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2019-02-13 |