NPI | 1992322770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11007794) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11007794) |
Enumeration Date | 2020-06-29 |
Last Update Date | 2022-06-19 |