| NPI | 1720772148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11026781) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11026781) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11026781) | |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2024-08-28 |