| NPI | 1629621917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11011213) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9234063) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL APRN11011213) | |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: FL APRN11011213) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2021-05-26 |