| NPI | 1235694167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11001283) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11001283) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2022-02-01 |