NPI | 1932753456 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11002533) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002533) |
363LF0000X Nurse Practitioner, Family (Licence: CA 95012121) | |
Enumeration Date | 2019-08-01 |
Last Update Date | 2023-11-02 |