| NPI | 1821123803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9334592) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 4425p) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2017-04-11 |