| NPI | 1568545135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11023036) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 1513) |
| 163W00000X Registered Nurse (Licence: FL RN9533439) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL APRN11023036) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2023-02-15 |