NPI | 1912523481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11007560) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11007560) |
Enumeration Date | 2020-06-22 |
Last Update Date | 2025-05-09 |