| NPI | 1013529007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11007959) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ01051400) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2020-11-17 |