| NPI | 1578982575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP 9285722) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9285722) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2024-05-08 |