| NPI | 1205468642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: FL 11031606) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: NY 574711-1) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2024-03-04 |