| NPI | 1114408457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9258729) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9258729) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2018-10-08 |