| NPI | 1609056811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9235643) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9235643) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2024-03-17 |