| NPI | 1679117451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11006004) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9265919) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL APRN11006004) | |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2024-02-15 |