| NPI | 1003466830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11010517) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9423141) |
| 163WH0200X Registered Nurse, Home Health (Licence: FL RN9423141) | |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2023-04-03 |