| NPI | 1649712563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9404039) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: FL APRN9404039) |
| 363L00000X Nurse Practitioner (Licence: FL APRN9404039) | |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2025-03-03 |