| NPI | 1548808439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11005321) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11005321) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2020-02-03 |