NPI | 1033461603 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9258243) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI APRN04621) |
Enumeration Date | 2012-10-08 |
Last Update Date | 2025-07-14 |