| NPI | 1902200850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9429186) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN190694) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9429186) | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2023-07-21 |