| NPI | 1750138962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: FL APRN11040277) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11040277) |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2026-07-21 |