| NPI | 1447814488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 13406988-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11001753) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2026-01-27 |