| NPI | 1467434076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN2941622) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN2941622) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2024-03-20 |