NPI | 1629645973 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11013348) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL APRN11013348) |
Enumeration Date | 2021-06-07 |
Last Update Date | 2023-10-09 |