| NPI | 1235902081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11029114) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11029114) |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2025-03-10 |