| NPI | 1821738006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11018788) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11018788) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2024-12-19 |