| NPI | 1225608284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11012754) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11012754) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2022-01-20 |