| NPI | 1649237512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP3018142) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: SC A95318) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NC 5005055) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: NC 5005055) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2018-03-17 |