| NPI | 1265853634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9391022) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: FL APRN9391022) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: FL APRN9391022) | |
| Enumeration Date | 2014-01-02 |
| Last Update Date | 2022-09-17 |