| NPI | 1528352192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9186795) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: FL APRN9186795) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2021-03-31 |