| NPI | 1669957221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9378140) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL ARNP9378140) |
| Enumeration Date | 2018-09-30 |
| Last Update Date | 2020-02-03 |