| NPI | 1780967364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95006008) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9353539) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: TX 570228) | |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2018-03-17 |