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 |