| NPI | 1730797713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11009352) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN9199348) |
| 363LF0000X Nurse Practitioner Family (Licence: FL RN9354777) | |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2020-10-28 |