| NPI | 1407270788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9256567) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9256567) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9256567) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL F0214044) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9256567) | |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2020-10-28 |