| NPI | 1194499822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11023185) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 29028) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 29028) | |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2024-03-05 |