| NPI | 1093469215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11017280) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL APRN11017280) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL APRN11017280) | |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-02-07 |