| NPI | 1144707183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9374283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL APRN9374283) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN9374283) | |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2022-01-28 |