| NPI | 1396434510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11019407) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11019407) |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2023-05-03 |