| NPI | 1518487776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11021099) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5013438) |
| 363L00000X Nurse Practitioner (Licence: NC 5013438) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-04-09 |