| NPI | 1184479529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 38613) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9571150) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11034469) | |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2025-08-25 |