NPI | 1093349052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11006150) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006150) |
Enumeration Date | 2020-02-28 |
Last Update Date | 2025-07-15 |