| NPI | 1669026738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11003495) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11003495) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2019-12-12 |