| NPI | 1144947284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11033304) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL APRN11033304) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R257284) | |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2026-01-02 |