| NPI | 1518308923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9295142) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 647396) |
| 163W00000X Registered Nurse (Licence: FL 9295142) | |
| 363L00000X Nurse Practitioner (Licence: NC 50100977) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 647396) | |
| Enumeration Date | 2013-07-13 |
| Last Update Date | 2019-03-11 |