| NPI | 1063407880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9202171) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: FL ARNP 9202171) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2015-01-16 |