| NPI | 1659704765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9236640) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9236640) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9236640) | |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2019-06-28 |