| NPI | 1487835245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN3327212) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: FL 3327212) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2022-06-08 |