| NPI | 1548815251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11002948) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11002948) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2021-03-09 |