| NPI | 1275087306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9266327) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN259371) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2023-04-20 |