| NPI | 1831627652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9366815) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL 9366815) |
| 363L00000X Nurse Practitioner (Licence: VA 0024176115) | |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2025-01-31 |