| NPI | 1053954420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL aprn11004542) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL aprn11004542) |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2026-04-05 |