| NPI | 1184205775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11012419) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11012419) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2023-02-06 |