| NPI | 1457712002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9250357) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9250357) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2022-07-18 |