| NPI | 1245540145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11013114) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MD R162164) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2021-08-05 |