NPI | 1306657713 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11034061) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11034061) |
363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11034061) | |
Enumeration Date | 2025-01-15 |
Last Update Date | 2025-01-15 |