| NPI | 1285040907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11005012) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11005012) |
| 104100000X Social Worker | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2024-02-10 |