| NPI | 1578914271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9366464) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9366464) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2018-05-04 |