| NPI | 1952773459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9332740) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9332740) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2018-07-11 |