| NPI | 1114482130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11001391) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11001391) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11001391) | |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2025-12-16 |