| NPI | 1669142527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11014189) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11014189) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2024-03-14 |