| NPI | 1457753980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11035758) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS40643) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2024-10-08 |