| NPI | 1578887477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN3154412) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP3154412) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2025-06-06 |