| NPI | 1871076638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN2931212) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP2931212) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2023-02-28 |