| NPI | 1891102372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: FL APRN9459224) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IN 28175065A) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN9459224) | |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: IN 28175065A) | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2023-04-19 |