| NPI | 1376037549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11038068) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5010631) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2025-03-27 |