| NPI | 1831643170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9286750) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 10636) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2023-01-17 |