| NPI | 1770761348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP1818802) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN1818802) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2019-10-08 |