| NPI | 1992177158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: FL ARNP9181162) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9181162) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2017-02-06 |