NPI | 1841710118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11024993) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11024993) |
363LF0000X Nurse Practitioner, Family (Licence: WI 7771-33) | |
Enumeration Date | 2017-06-27 |
Last Update Date | 2025-09-30 |