| NPI | 1568132207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11015992) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL 9423404) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2021-10-27 |