| NPI | 1346014214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11040091) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA sp028634) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: PA sp028634) | |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2025-11-17 |