| NPI | 1316449515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9385496) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL RN9385496) |
| Enumeration Date | 2018-03-03 |
| Last Update Date | 2018-05-21 |