| NPI | 1134771025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11003193) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL 11003193) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2025-05-29 |