| NPI | 1215634092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11024551) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024551) |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2024-02-08 |