NPI | 1538897855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11021298) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11021298) |
363LF0000X Nurse Practitioner, Family (Licence: FL 11021298) | |
Enumeration Date | 2022-08-13 |
Last Update Date | 2023-03-03 |