| NPI | 1326393075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9360397) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC006535) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9360397) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02002) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2024-05-10 |