| NPI | 1801353503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1128686) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 35665) |
| 363L00000X Nurse Practitioner (Licence: SC 28796) | |
| 363L00000X Nurse Practitioner (Licence: FL APRN11029288) | |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2024-06-06 |