| 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 |