NPI | 1134504079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9169328) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP 9169328) |
Enumeration Date | 2015-07-21 |
Last Update Date | 2025-02-18 |