| NPI | 1326449117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11031684) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: VA 0001250803) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2025-07-08 |