| NPI | 1619449246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11000667) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11000667) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2019-08-05 |