| 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 |