| NPI | 1780427773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11033970) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F06241642) |
| 163WP2201X Registered Nurse, Ambulatory Care (Licence: FL RN9437064) | |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-08-02 |