| NPI | 1609310770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9293639) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9293639) |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2021-02-16 |