| NPI | 1801893938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9208291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ARNP9208291) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R133985) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2021-11-29 |