| NPI | 1447809744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11015991) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9735526) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11015991) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015991) | |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2024-01-11 |