| NPI | 1043459563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11025366) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 574074-1) |
| 163W00000X Registered Nurse (Licence: FL RN9623430) | |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2025-06-12 |