| NPI | 1043918626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11024122) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: FL APRN11024122) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11024122) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN11024122) | |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2024-03-28 |