| NPI | 1326453374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11016182) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9352017) |
| Enumeration Date | 2014-06-29 |
| Last Update Date | 2024-09-11 |