| NPI | 1356798268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9269199) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9269199) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2020-08-18 |