| NPI | 1902220593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9437549) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: DC RN1023062) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2016-11-08 |