| NPI | 1770170532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11010420) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11010420) |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2021-03-11 |