| NPI | 1730367418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9228626) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9228626) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2023-08-03 |