| NPI | 1134803240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11030621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9546404) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11030621) | |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2024-11-20 |