| NPI | 1184195083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11000603) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL APRN11000603) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL aprn11000603) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2025-01-22 |