| NPI | 1790231793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9281153) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN9281153) |
| 363LF0000X Nurse Practitioner Family (Licence: GA RN196945) | |
| 363LF0000X Nurse Practitioner Family (Licence: NM 66109) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2022-05-24 |