| NPI | 1699117903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9207498) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN 9207498) |
| Enumeration Date | 2013-07-28 |
| Last Update Date | 2022-07-21 |