| NPI | 1093183444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11001332) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9401504) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2022-04-13 |