| NPI | 1174989115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9372257) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 4337) |
| 363L00000X Nurse Practitioner (Licence: NM CNP-03142) | |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2018-06-15 |