| NPI | 1609408939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11006043) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9292509) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2020-02-05 |