| NPI | 1164022802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: FL APRN11007971) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9400203) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |