| NPI | 1235464595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9203928) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9203928) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 9203928) | |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2022-02-02 |