| NPI | 1477106136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11003310) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health (Licence: FL 11003310) |
| 363LF0000X Nurse Practitioner Family (Licence: FL 11003310) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: FL 11003310) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: FL 11003310) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL 11003310) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: FL 11003310) | |
| 363LS0200X Nurse Practitioner School (Licence: FL 11003310) | |
| 363LX0106X Nurse Practitioner Occupational Health (Licence: FL 11003310) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: FL 11003310) | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2021-06-01 |