NPI | 1275916165 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11001912) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 28224842A) |
Enumeration Date | 2015-07-09 |
Last Update Date | 2019-05-08 |