| NPI | 1710388871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9390792) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WV 110747) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WV 110747) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9390792) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WV 110747) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2021-11-01 |