NPI | 1962048702 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11005237) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11005237) |
Enumeration Date | 2019-11-26 |
Last Update Date | 2021-07-21 |