| NPI | 1962756577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9295737) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: FL ARNP9295737) |
| Enumeration Date | 2012-11-04 |
| Last Update Date | 2017-08-15 |