| NPI | 1598765786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP1757172) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL MD.32707) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2017-01-05 |