| NPI | 1235589318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11020218) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN223208) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-10-27 |