| NPI | 1336847821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11039416) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R226013) |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2025-11-24 |