| NPI | 1497260616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9342969) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9342969) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2018-09-04 |