| NPI | 1992131460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 9220584) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9220584) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2024-04-05 |