| NPI | 1750833638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9407216) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9407216) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2020-12-04 |