| NPI | 1982130928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9302764) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9302764) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9302764) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-05-07 |