NPI | 1033751409 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11004590) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004590) |
Enumeration Date | 2019-10-17 |
Last Update Date | 2022-02-11 |