| NPI | 1407159536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9172707) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9172707) |
| 363L00000X Nurse Practitioner (Licence: FL APRN9172707) | |
| Enumeration Date | 2010-12-11 |
| Last Update Date | 2023-12-19 |