NPI | 1780673509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN3413732) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP3413732) |
Enumeration Date | 2005-10-14 |
Last Update Date | 2024-05-29 |