| NPI | 1356027809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11027103) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11027103) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2023-07-18 |