| NPI | 1184062564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014817) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9205194) |
| 163WA2000X Registered Nurse, Administrator (Licence: FL ARNP9205194) | |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2023-10-09 |