| NPI | 1467972596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9357022) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9357022) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-01-13 |