| NPI | 1306223011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9326777) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9326777) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2020-12-25 |