| NPI | 1447617527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN9269955) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9269955) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2021-12-16 |