NPI | 1538187158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11012019) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-045071) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2025-08-03 |