| NPI | 1972099844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9336759) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9336759) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2023-04-14 |