| NPI | 1184291270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 347375) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11015412) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2024-06-10 |