NPI | 1336825660 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11027125) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11027125) |
Enumeration Date | 2023-06-22 |
Last Update Date | 2025-03-26 |