| NPI | 1841368669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 9190646) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9190646) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9190646) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2017-01-16 |