NPI | 1306654447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11037558) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 2023129213) |
Enumeration Date | 2024-12-20 |
Last Update Date | 2025-02-28 |