| NPI | 1962945493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN9344161) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9344161) |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2020-05-20 |