| NPI | 1578772828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9218893) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9218893) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11015091) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-05-27 |