| NPI | 1376810192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11012534) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP011787) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2021-12-14 |