| NPI | 1891495453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL EDOH4420Z) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9338250) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-03-03 |