| NPI | 1467854109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11006402) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN 9381306) |
| 363LF0000X Nurse Practitioner, Family (Licence: ID 70118) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN 228872) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006402) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: FL PMD 526814) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: GA 8557) | |
| 163W00000X Registered Nurse (Licence: ID 70118) | |
| 163W00000X Registered Nurse (Licence: GA RN 228872) | |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2022-07-04 |