NPI | 1588319669 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11020248) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.404315) |
163W00000X Registered Nurse (Licence: FL RN9415571) | |
Enumeration Date | 2022-02-16 |
Last Update Date | 2022-08-02 |