| NPI | 1255833513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9314595) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9314595) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2020-04-15 |