| NPI | 1609641067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11030970) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9518042) |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2024-02-05 |