| NPI | 1770559049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11026956) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NH 049253-23) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NH 049253-23) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-08-05 |