| NPI | 1003309212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9301348) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9301348) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2021-02-19 |