| NPI | 1922705524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11025005) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9325710) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-04-06 |