| 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 |