| NPI | 1710423132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9299997) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9299997) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9299997) | |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2024-05-01 |