| NPI | 1215400189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL APRN11001553) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9391610) |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2019-02-20 |