| NPI | 1881289791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12659) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11011798) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11011798) | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2023-12-06 |