| NPI | 1780035048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: FL APRN9251304) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL RN9251304) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2024-08-09 |