| NPI | 1922449180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9263126) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9263126) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9263126) | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2022-12-01 |