| NPI | 1063834653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9278598) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9278598) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2025-03-21 |