| NPI | 1093276081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: FL APRN11009848) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9479917) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2021-02-17 |