| NPI | 1467951012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN1001806) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9442477) |
| 363L00000X Nurse Practitioner (Licence: FL APRN1001806) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN1001806) | |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2020-04-03 |