| NPI | 1356622419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11005845) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5008652) |
| 363L00000X Nurse Practitioner (Licence: KY 3007121) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2024-11-07 |