| NPI | 1538685961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9266385) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL ARNP9266385) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2021-05-27 |