| NPI | 1538779483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11007972) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11007972) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11007972) | |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2022-11-09 |