| NPI | 1750125688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11026965) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11026965) |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2024-09-24 |