| NPI | 1497384192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 79857) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11004511) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2023-07-10 |