| NPI | 1174619027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN1848262) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP 1848262) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2024-09-05 |