| NPI | 1962839738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL MW4154528) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9211318) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP09077) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9211318) | |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2023-09-21 |