| 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 |