NPI | 1063258994 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11035022) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 352149) |
Enumeration Date | 2024-07-01 |
Last Update Date | 2025-09-03 |