| NPI | 1568892552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9314833) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9314833) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9314833) | |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2024-09-18 |