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 |