| NPI | 1124890561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11029444) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11029444) |
| 363L00000X Nurse Practitioner (Licence: FL 11029444) | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2025-11-17 |