| NPI | 1063117042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11018843) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95023758) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11018843) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11018843) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11018843) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95023758) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95023758) | |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2025-10-21 |