| NPI | 1427567411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9406634) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI APRN02217) |
| 363L00000X Nurse Practitioner (Licence: RI APRN02217) | |
| 363L00000X Nurse Practitioner (Licence: FL APRN9406634) | |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2022-02-21 |