| NPI | 1982213708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11008471) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9234025) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2023-10-11 |