| NPI | 1114766623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11033158) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL RN9494162) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2024-07-12 |