| NPI | 1154625580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 18790) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9348388) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 363L00000X Nurse Practitioner (Licence: MN R199354-3) | |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2022-03-31 |