| NPI | 1144528522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9217644) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL ARNP9217644) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9217644) | |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2016-11-15 |