| NPI | 1962595652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN3031852) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP3031852) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-08-22 |